Linkfest Today, April 15, 2010

Pain management continues to be a challenge for doctors, and is a controversial topic whenever it's discussed.

Controlling pain and preventing patients from being addicted to opioid medications is a delicate balance. In some cases, however, doctors may be too aggressive in the acute setting, and start patients on drugs with a strong habit-forming potential.

In a guest post, Michael Kirsch gives an example. "It is now common to medicate patients with chronic
abdominal pain – stomach aches – with IV Dilaudid, a powerful and
addictive narcotic," he writes. "Unlike acute pain, which will terminate, chronic
pain lives on. Therefore, if a physician opts to prescribe addictive
medicines to these patients, then what is the exit strategy."

Too often, this is left to the primary care doctor after a patient leaves the hospital, who often does not have the necessary training to treat chronic pain appropriately. A smoother transition to a pain management specialist needs to be a priority.

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There is an increased focus, rightly, on patient safety. But medical residents continue to be trained in an antiquated hospital culture that promotes fear.

That's the conclusion from a recent report on medical education. According to the Lucian Leape Institute of the National Patient Safety Foundation, "Young doctors are being educated in a toxic culture. The current
environment is hierarchical, stressful for the individual, driven by the
fee-for-service payment system and humiliating, all of which works
against improving patient safety."

Simple steps, like teaching doctors to fill out an incident report, can go a long way to protecting patients. But changing that culture begins early in medical school -- and that's something our academic physician leaders need to take more seriously.